Large differences in lifetime physician earnings

(Medical Xpress)—A national study has found that earnings over the course of the careers of primary-care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues, potentially making primary care a less attractive choice for medical school graduates and exacerbating the already significant shortage of medical generalists.

The results, published online in the journal Medical Care, lead the study's authors to recommend reducing disparities in physician pay to ensure adequate access to primary care, which has been shown to improve health and reduce health-care costs.

"The need for primary-care providers is greater than ever before and expected to grow as millions more Americans become insured under the Affordable Care Act," said J. Paul Leigh, lead author of the study, professor of public health sciences and researcher with the UC Davis Center for Healthcare Policy and Research. "Without a better payment structure, there will be extraordinary demands on an already scarce resource."

According to projections by the Association of American Medical Colleges, the nation is likely to face a shortage of more than 65,000 primary-care physicians by 2025.

For the nationwide study, a follow-up to 2010 research by Leigh and his colleagues on differences in annual wages by specialty, the investigators compared lifetime earnings to demonstrate how annual wage differences accumulate over physicians' careers. The earnings data came from the 2004-05 Community Tracking Study, a periodic evaluation of physician demographic, geographic and market trends.

To ensure valid comparisons, the data were adjusted to account for factors that affect earnings, including age, sex, race, board certification, graduation from a foreign medical school, rural residence, employment by an academic medical school and residency program length.

Incomes were then evaluated for more than 6,000 doctors practicing in 41 specialties. When merged into four broad career categories, lifetime earnings in surgery, internal medicine and pediatric subspecialties, and all other medical specialties averaged from $761,402 to $1,587,722 higher than in primary care:

Primary care (geriatrics, family practice, general practice, general internal medicine and general pediatrics): $3,000,527

The earnings differences were more dramatic when compared as 41 separate specialties. Medical oncologists, for instance, earn up to $7,127,543 during a 35-year career, while family medicine practitioners earn as low as $2,838,637.

Leigh surmised that one reason for the earnings differences is the tendency for Medicare administrators to utilize recommendations from an American Medical Association committee on physician pay that price specialist procedures far higher than primary-care office visits. Private insurance companies, in turn, tend to adopt Medicare pay rates.

The authors noted that efforts are under way to resolve physician pay differences. For example, the Affordable Care Act requires states to pay primary-care physicians no less than 100 percent of Medicare payment rates for primary-care services provided to Medicaid patients. The study's senior author, Richard Kravitz, a UC Davis professor of internal medicine, also serves on an independent commission to assess physician pay.

"These huge lifetime pay disparities have to be discouraging for medical students considering primary care as a career," said Kravitz. "If we truly value primary care, we need payment schemes that don't send the opposite message."

National Institute for Occupational Safety and Health grants (OH008248-01 and U54OH007550) provided partial support for the study. In addition to Leigh and Kravitz, other study authors were Daniel Tancredi, Anthony Jerant and Patrick Romano, all of the UC Davis School of Medicine.

The study, titled "Lifetime Earnings for Physicians across Specialties," will appear in the December print issue of Medical Care.

The nation's shortage of primary care physicians has been linked to a host of poor health outcomes, and a new study published in the Journal of the American Medical Association suggests that salary disparities play a majo ...

A shortage in the number and availability of primary care physicians may continue to mean rising numbers of emergency department visits, despite the expanded health insurance coverage required by the 2010 Patient Protection ...

A survey conducted by the American College of Physicians (ACP) and the American Board of Internal Medicine (ABIM) found that 9 percent of all internists originally certified between 1990 and 1995, including a significantly ...

Recommended for you

The American Thoracic Society has published the results of a survey of the ATS membership on climate change which found that the majority of ATS members believe that climate change is real and that it is having a negative ...

A new study by the University of Texas Medical Branch found that 20 percent of men were prescribed testosterone despite having normal testosterone levels based on the Endocrine Society's guidelines. The study ...

A new study by California scientists has linked chronic exposure to microscopic air pollutants in vehicle exhaust to deaths from heart disease. The finding bolsters evidence that ultrafine particles, which are not regulated ...

Attendance at schools exposed to high levels of traffic-related air pollution is linked to slower cognitive development among 7-10-year-old children in Barcelona, according to a study published by Jordi Sunyer ...

Before she got pregnant in 2014, Lizzy King, 28, of East Lansing, Mich., gave herself a "lifestyle overhaul." She started running and lost 50 pounds. She eschewed processed food and ate her first banana.

Smokers have become accustomed to stepping outside at bars and restaurants. But has the change in rules governing enclosed public places inspired enough of them to smoke less behind their own closed doors ...

User comments

Please sign in to add a comment.
Registration is free, and takes less than a minute.
Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.